Abstract
Background: The impact of ticagrelor-based dual antiplatelet therapy (DAPT) on acute coronary syndrome (ACS) in patients with chronic kidney disease (CKD) remains unclear.Methods: Data on a total of 1,067 ACS patients with CKD including end-stage renal disease (ESRD) who underwent new-generation drug-eluting stent implantation were extracted from a multicenter registry. This study aimed to compare outcomes of patients treated with ticagrelor- (n = 449) and those treated with clopidogrel-based (n = 618) DAPT. Outcomes of interest included major adverse cardiac and cerebrovascular events (MACCEs) and bleeding (Bleeding Academic Research Consortium grade 3 or 5) at 12 months. Propensity-score matching (346 pairs) analysis was performed.Results: The patients with ESRD showed the highest MACCE and bleeding rates (P < 0.001). There was no difference in the rate of MACCEs between the treatment groups (7.8% vs. 8.4%; hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.56–1.61, P = 0.855); however, a trend toward an increased bleeding rate was observed in the ticagrelor-based DAPT group (6.8% vs. 3.8%, HR = 1.84, 95% CI = 0.93–3.63, P = 0.079). Among patients with CKD stage III/IV but without ESRD (277 pairs), the ticagrelor-based DAPT group showed a reduced MACCE rate (3.6% vs. 8.7%, HR = 0.41, 95% CI = 0.19–0.86, P = 0.018) and a similar bleeding rate (5.1% vs. 3.2%, HR = 1.61, 95% CI = 0.70–3.71, P = 0.267), compared with those of the clopidogrel-based DAPT group.Conclusion: The effects of ticagrelor-based DAPT on ischemic and bleeding outcomes of ACS patients with CKD varied according to CKD stage; in ACS patients with CKD without ESRD, ticagrelor-based DAPT reduced MACCE risk without increasing bleeding risks, relative to those observed with clopidogrel-based DAPT.
Highlights
Several studies suggest that ticagrelor has superior efficacy over clopidogrel in reducing the risk of major adverse cardiovascular events in patients with acute coronary syndrome (ACS) [1,2,3]
The present study aimed to compare clinical outcomes of patients with ACS and chronic kidney disease (CKD) treated with the new-generation drug-eluting stent (DES), stratified by CKD stage, and dichotomized based on P2Y12 inhibitor type used in dual antiplatelet therapy (DAPT)
Between 2013 and 2019, data on a total of 1,268 patients with CKD, including those with end-stage renal disease (ESRD), who presented with ACS and underwent percutaneous coronary intervention (PCI) using new-generation DES were obtained from the prospective Korean multicenter angioplasty team (NCT03908463) and Bucheon St
Summary
Several studies suggest that ticagrelor has superior efficacy over clopidogrel in reducing the risk of major adverse cardiovascular events in patients with acute coronary syndrome (ACS) [1,2,3]. Chronic kidney disease (CKD), including end-stage renal disease (ESRD), is a well-documented risk factor for recurrent ischemic major adverse cardiac and cerebrovascular events (MACCEs) and bleeding events [7, 8], the optimal antiplatelet strategy for patients with CKD remains unclear due to the lack of clinical trial-based evidence [4, 8]. The present study aimed to compare clinical outcomes of patients with ACS and CKD treated with the new-generation DES, stratified by CKD stage, and dichotomized based on P2Y12 inhibitor type used in DAPT (ticagrelor vs clopidogrel). The impact of ticagrelor-based dual antiplatelet therapy (DAPT) on acute coronary syndrome (ACS) in patients with chronic kidney disease (CKD) remains unclear
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